Sunday, April 18, 2010 charlane marty schmidt asks

Q: Is nine thousand dollars an unreasonable amount for a Reclast infusion? Seems outrageous to me!

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Answers (3)

4/19/10 4:03pm

Hi charlane, welcome...I would say that is an unreasonable amount. Do you have insurance? The last price quote I recieved was approximately $1,200.00 for the infusion.

I really don't understand where this price is coming from. Is the infusion center or hospital quoting this or someone else? If you could let me know that would help. If you don't have insurance and are paying the retail price, it still shouldn't be that high.

If you could elaborate on who gave you this price it might help...

charlane marty schmidt

4/19/10 7:35pm

I received the Reclast IV at my doctor's office. Beloit Clinic and Beloit Memorial Hospital have now merged, so all Medicare billing comes through the hospital. The hospital sent me a bill for $8994.89 for the Reclast IV infusion. I do have Medicare and WPS, with a $2500.00 deductible. This was an optional treatment and had I known the cost of it, I would not have considered it. Have been on Boniva IV treatments for two years and they cost $666.00.

May I ask who you are and what is your job description? Thank you.

Charlane Schmidt

Pam Flores, Health Guide

4/19/10 8:09pm

Hi Charlane, have you looked into an appeal of the cost? This price seems really high to me, but I realize some of these treatments have gone up in price, I just didn't know by how much since each of us pay according to what our insurance allows.

I'm a patient advocate, and I also have osteoporosis. You are more than welcome to read my profile here to see if that explains it to your satisfaction.

I'm not sure what WPS is; is it some kind of secondary insurance? I would also contact Medicare and explain that you had no idea of the cost and what do they suggest you do if you can't afford it. Did the hospital/doctors office have you sign anything that explained you'd be responsible for any charges Medicare didn't cover? If not, then you certainly weren't made aware of the possible cost. If you want to appeal this, find out how to do that through MC and have your doctor fill out any necessary forms. You can also look in you MC handbook for 2010 for the section on appeals which should give you enough information to start the process.

If you weren't given any paperwork, at the time of infusion, regarding the cost, I would mention that also, since there would be no way you'd know what you'd have to pay.

Good luck finding out about this and I hope you are successful. If you don't succeed on the first try, try again.

Pam Flores, Health Guide

4/19/10 8:19pm

Hi again, we are having some technical problems and the link to my profile didn't show up. Here's the link to Pam Flores Profile. To see any of our writers profiles just click on there name next to their photo.

Pam Flores, Health Guide

4/20/10 4:37pm

Hi, one thing I forgot to mention is that Medicare pays 80% of the "assigned" amount (whatever that is) and you are responsible for the 20% of that figure minus any deductible. I've also never heard of a $2,500.00 deductible, but that might have something to do with the type of MC coverage you have. See annual deductible for Part B on pages 123-125 of the MC handbook for the 2010 figures. Appeals are on page 86. If your doctor accepts assignments, this can also save you money (assignment means the doctor accepts the amount paid by MC as full payment). The above deductible info applies to "original Medicare" not a stand-alone, HMO, or PPO policy, and Reclast is covered under Part B, not under Part D or A, as I'm sure you know.

Good luck...

Sue Mohr

2/ 6/11 2:39pm

I work with insurance at a chiropractic office and would like to correct your statement that "Medicare pays 80% of the assigned amount". The correct wordage is 80% of the "approved" amount. That is the amount that Medicare says a provider may receive for a given service. Keep in mind that non-medicare patients would be required to pay the entire fee for the service.

Pam Flores, Health Guide

2/ 6/11 2:49pm

Thanks Sue, for the correction!!

dss

4/27/10 9:53am

I just received the EOB from my insurance company and could not believe the original charge - $6400! Reduced to $2700 and fully paid by insurance but I am shocked and really unsure I will do this next year. Yes,I have good insurance and will continue it into retirement but this is obscene! I have called the hopsital and requested an itemized statement. I will also bring this tothe attentionof my gynocologist to make sure she knows this.

Pam Flores, Health Guide

4/27/10 11:56am

Hi dss, welcome... Wow that is a lot for Reclast. I'm glad your insurance paid all of it. It would be interesting to hear about the itemized bill, if you could tell us.

Good luck...

Betsy

8/ 2/10 3:18pm

The Reclast infusion I received cost just below $9000. I was told it would be about $1200 but later learned that the $1200 was per unit of Reclast. It takes I believe 5 units plus the cost of the infusion process and the hospital outpatient staff. I called medicare, the hospital and the manufacturer all of whom said the total was normal. Not for me ... Medicare covered the infusion, but if you multiply the number of baby boomers by the cost of an infusion by the requisite number of years -- seems that Medicare will go broke. Trying Evista for now and looking forward to better treatment in the future.

martin tschida

6/30/11 10:37pm

I just received the explanation of benefits form for my wifes recent Reclas Infusion. The charge for the prescription drug was $12,636.70 medical care was $125.00. This number for this drug seems to be way out of wack. Any comments?

kat

10/31/11 2:33pm

To all, I also received the Reclast infusion, it was done in the hospital chemo room setting. My FEP BC/BS paid 3367.00 for the Reclast prescription for this. I called them to say although I didn't have to pay this amount I thought it was an outrageous amount and were they checking into it. They informed me that I received 5 units (at least that's the way it was coded and billed) and that the 800.00+ per unit was normal. I still do not consider this normal for a charge and think it is just another case of all of us being ripped off by drug companies and insurance companies.

Q: Is nine thousand dollars an unreasonable amount for a Reclast infusion? Seems outrageous to me!

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